scholarly journals MR imaging by 3D T1-weighted black blood sequences may improve delineation of therapy-naive high-grade gliomas

2020 ◽  
Author(s):  
Tom Finck ◽  
Jens Gempt ◽  
Claus Zimmer ◽  
Jan S. Kirschke ◽  
Nico Sollmann
Keyword(s):  
Contrast Enhancement ◽  
Spin Echo ◽  
World Health ◽  
Black Blood ◽  
High Grade ◽  
Who Grade ◽  
Oncological Treatment ◽  
Contrast Enhanced ◽  
High Grade Gliomas ◽  
Turbo Field Echo

Abstract Objectives To investigate the value of contrast-enhanced (CE) turbo spin echo black blood (BB) sequences for imaging of therapy-naive high-grade gliomas (HGGs). Methods Consecutive patients with histopathologically confirmed World Health Organization (WHO) grade III or IV gliomas and no oncological treatment prior to index imaging (March 2019 to January 2020) were retrospectively included. Magnetic resonance imaging (MRI) at 3 Tesla comprised CE BB and CE turbo field echo (TFE) sequences. The lack/presence of tumor-related contrast enhancement and satellite lesions were evaluated by two readers. Sharper delineation of tumor boundaries (1, bad; 2, intermediate; 3, good delineation) and vaster expansion of HGGs into the adjacent brain parenchyma on CE BB imaging were the endpoints. Furthermore, contrast-to-noise ratios (CNRs) were calculated and compared between sequences. Results Fifty-four patients were included (mean age: 61.2 ± 15.9 years, 64% male). The vast majority of HGGs (51/54) showed contrast enhancement in both sequences, while two HGGs as well as one of six detected satellite lesions were depicted in CE BB imaging only. Tumor boundaries were significantly sharper (R1: 2.43 ± 0.71 vs. 2.73 ± 0.62, p < 0.001; R2: 2.44 ± 0.74 vs. 2.77 ± 0.60, p = 0.001), while the spread of HGGs into the adjacent parenchyma was larger when considering CE BB sequences according to both readers (larger spread in CE BB sequences: R1: 23 patients; R2: 20 patients). The CNR for CE BB sequences significantly exceeded that of CE TFE sequences (43.4 ± 27.1 vs. 32.5 ± 25.0, p = 0.0028). Conclusions Our findings suggest that BB imaging may considerably improve delineation of therapy-naive HGGs when compared with established TFE imaging. Thus, CE BB sequences might supplement MRI protocols for brain tumors. Key Points • This study investigated contrast-enhanced (CE) T1-weighted black blood (BB) sequences for improved MRI in patients with therapy-naive high-grade gliomas (HGGs). • Compared with conventionally used turbo field echo (TFE) sequences, CE BB sequences depicted tumor boundaries and spread of HGGs into adjacent parenchyma considerably better, which also showed higher CNRs. • Two enhancing tumor masses and one satellite lesion were exclusively identified in CE BB sequences, but remained undetected in conventionally used CE TFE sequences.

scholarly journals High-grade gliomas in adolescents and young adults highlight histomolecular differences from their adult and pediatric counterparts

2020 ◽  
Vol 22 (8) ◽  
pp. 1190-1202 ◽  
Author(s):  
Alexandre Roux ◽  
Johan Pallud ◽  
Raphaël Saffroy ◽  
Myriam Edjlali-Goujon ◽  
Marie-Anne Debily ◽  
...  
Keyword(s):  
Young Adults ◽  
Molecular Techniques ◽  
Adolescents And Young Adults ◽  
World Health ◽  
High Grade ◽  
Who Grade ◽  
Targeted Next Generation Sequencing ◽  
Integrated Diagnosis ◽  
Idh Mutations ◽  
High Grade Gliomas

Abstract Background Considering that pediatric high-grade gliomas (HGGs) are biologically distinct from their adult counterparts, the objective of this study was to define the landscape of HGGs in adolescents and young adults (AYAs). Methods We performed a multicentric retrospective study of 112 AYAs from adult and pediatric Ile-de-France neurosurgical units, treated between 1998 and 2013 to analyze their clinicoradiological and histomolecular profiles. The inclusion criteria were age between 15 and 25 years, histopathological HGG diagnosis, available clinical data, and preoperative and follow-up MRI. MRI and tumoral samples were centrally reviewed. Immunohistochemistry and complementary molecular techniques such as targeted/next-generation sequencing, whole exome sequencing, and DNA-methylation analyses were performed to achieve an integrated diagnosis according to the 2016 World Health Organization (WHO) classification. Results Based on 80 documented AYA patients, HGGs constitute heterogeneous clinicopathological and molecular groups, with a predominant representation of pediatric subtypes (histone H3-mutants, 40%) but also adult subtypes (isocitrate dehydrogenase [IDH] mutants, 28%) characterized by the rarity of oligodendrogliomas, IDH mutants, and 1p/19q codeletion and the relative high frequency of “rare adult IDH mutations” (20%). H3G34-mutants (14%) represent the most specific subgroup in AYAs. In the H3K27-mutant subgroup, non-brainstem diffuse midline gliomas are more frequent (66.7%) than diffuse intrinsic pontine gliomas (23.8%), contrary to what is observed in children. We found that WHO grade has no prognostic value, but molecular subgrouping has major prognostic importance. Conclusions HGGs in AYAs could benefit from a specific classification, driven by molecular subtyping rather than age group. Collaborative efforts are needed from pediatric and adult neuro-oncology teams to improve the management of HGGs in AYAs.

Amide proton transfer imaging for differentiation of tuberculomas from high-grade gliomas: Preliminary experience

2021 ◽  
pp. 197140092110027
Author(s):  
Karthik Kulanthaivelu ◽  
Shumyla Jabeen ◽  
Jitender Saini ◽  
Sanita Raju ◽  
Atchayaram Nalini ◽  
...  
Keyword(s):  
Proton Transfer ◽  
Chemical Exchange ◽  
Spin Echo ◽  
Chemical Exchange Saturation Transfer ◽  
Amide Proton ◽  
High Grade ◽  
Saturation Pulse ◽  
Amide Proton Transfer ◽  
High Grade Gliomas ◽  
Amide Protons

Purpose Tuberculomas can occasionally masquerade as high-grade gliomas (HGG). Evidence from magnetisation transfer (MT) imaging suggests that there is lower protein content in the tuberculoma microenvironment. Building on the principles of chemical exchange saturation transfer and MT, amide proton transfer (APT) imaging generates tissue contrast as a function of the mobile amide protons in tissue’s native peptides and intracellular proteins. This study aimed to further the understanding of tuberculomas using APT and to compare it with HGG. Method Twenty-two patients ( n = 8 tuberculoma; n = 14 HGG) were included in the study. APT was a 3D turbo spin-echo Dixon sequence with inbuilt B0 correction. A two-second, 2 μT saturation pulse alternating over transmit channels was applied at ±3.5 ppm around water resonance. The APT-weighted image (APTw) was computed as the MT ratio asymmetry (MTRasym) at 3.5 ppm. Mean MTRasym values in regions of interest (areas = 9 mm2; positioned in component with homogeneous enhancement/least apparent diffusion coefficient) were used for the analysis. Results MTRasym values of tuberculomas ( n = 14; 8 cases) ranged from 1.34% to 3.11% ( M = 2.32 ± 0.50). HGG ( n = 17;14 cases) showed MTRasym ranging from 2.40% to 5.70% ( M = 4.32 ± 0.84). The inter-group difference in MTRasym was statistically significant ( p < 0.001). APTw images in tuberculomas were notable for high MTRasym values in the perilesional oedematous-appearing parenchyma (compared to contralateral white matter; p < 0.001). Conclusion Tuberculomas demonstrate lower MTRasym ratios compared to HGG, reflective of a relative paucity of mobile amide protons in the ambient microenvironment. Elevated MTRasym values in perilesional parenchyma in tuberculomas are a unique observation that may be a clue to the inflammatory milieu.

scholarly journals T2 mapping of the peritumoral infiltration zone of glioblastoma and anaplastic astrocytoma

2021 ◽  
pp. 197140092198932
Author(s):  
Timo Alexander Auer ◽  
Maike Kern ◽  
Uli Fehrenbach ◽  
Yasemin Tanyldizi ◽  
Martin Misch ◽  
...  
Keyword(s):  
Relaxation Time ◽  
Isocitrate Dehydrogenase ◽  
Anaplastic Astrocytoma ◽  
T2 Mapping ◽  
Relaxation Times ◽  
Region Of Interest ◽  
World Health ◽  
High Grade ◽  
High Grade Gliomas ◽  
Health Organization

Purpose To characterise peritumoral zones in glioblastoma and anaplastic astrocytoma evaluating T2 values using T2 mapping sequences. Materials and methods In this study, 41 patients with histopathologically confirmed World Health Organization high grade gliomas and preoperative magnetic resonance imaging examinations were retrospectively identified and enrolled. High grade gliomas were differentiated: (a) by grade, glioblastoma versus anaplastic astrocytoma; and (b) by isocitrate dehydrogenase mutational state, mutated versus wildtype. T2 map relaxation times were assessed from the tumour centre to peritumoral zones by means of a region of interest and calculated pixelwise by using a fit model. Results Significant differences between T2 values evaluated from the tumour centre to the peritumoral zone were found between glioblastoma and anaplastic astrocytoma, showing a higher decrease in signal intensity (T2 value) from tumour centre to periphery for glioblastoma ( P = 0.0049 – fit-model: glioblastoma –25.02± 19.89 (–54–10); anaplastic astrocytoma –5.57±22.94 (–51–47)). Similar results were found when the cohort was subdivided by their isocitrate dehydrogenase profile, showing an increased drawdown from tumour centre to periphery for wildtype in comparison to mutated isocitrate dehydrogenase ( P = 0.0430 – fit model: isocitrate dehydrogenase wildtype –10.35±16.20 (–51) – 0; isocitrate dehydrogenase mutated 12.14±21.24 (–15–47)). A strong statistical proof for both subgroup analyses ( P = 0.9987 – glioblastoma R2 0.93±0.08; anaplastic astrocytoma R2 0.94±0.15) was found. Conclusion Peritumoral T2 mapping relaxation time tissue behaviour of glioblastoma differs from anaplastic astrocytoma. Significant differences in T2 values, using T2 mapping relaxation time, were found between glioblastoma and anaplastic astrocytoma, capturing the tumour centre to the peritumoral zone. A similar curve progression from tumour centre to peritumoral zone was found for isocitrate dehydrogenase wildtype high grade gliomas in comparison to isocitrate dehydrogenase mutated high grade gliomas. This finding is in accordance with the biologically more aggressive behaviour of isocitrate dehydrogenase wildtype in comparison to isocitrate dehydrogenase mutated high grade gliomas. These results emphasize the potential of mapping techniques to reflect the tissue composition of high grade gliomas.

scholarly journals Improvement of the Diagnostic Performance of Facial Neuritis Using Contrast-Enhanced 3D T1 Black-Blood Imaging: Comparison with Contrast-Enhanced 3D T1-Spoiled Gradient-Echo Imaging

2021 ◽  
Vol 10 (9) ◽  
pp. 1850
Author(s):  
Seun-Ah Lee ◽  
Sang-Won Jo ◽  
Suk-Ki Chang ◽  
Ki-Han Kwon
Keyword(s):  
Quantitative Analysis ◽  
Diagnostic Performance ◽  
Spin Echo ◽  
Fast Spin Echo ◽  
Black Blood ◽  
Gradient Echo ◽  
Diagnostic Confidence ◽  
Contrast Enhanced ◽  
Black Blood Imaging ◽  
Spoiled Gradient Echo

This study aims to investigate the diagnostic ability of the contrast-enhanced 3D T1 black-blood fast spin-echo (T1 BB-FSE) sequence compared with the contrast-enhanced 3D T1-spoiled gradient-echo (CE-GRE) sequence in patients with facial neuritis. Forty-five patients with facial neuritis who underwent temporal bone MR imaging, including T1 BB-FSE and CE-GRE imaging, were examined. Two reviewers independently assessed the T1 BB-FSE and CE-GRE images in terms of diagnostic performance, and qualitative (diagnostic confidence and visual asymmetric enhancement) and quantitative analysis (contrast-enhancing lesion extent of the canalicular segment of the affected facial nerve (LEC) and the affected side-to-normal signal intensity ratio (rSI)). The AUCs of each reviewer, and the sensitivity and accuracy of T1 BB-FSE were significantly superior to those of CE-GRE (p < 0.05). Regarding diagnostic confidence and visual asymmetric enhancement, T1 BB-FSE tended to be rated greater than CE-GRE (p < 0.05). Additionally, in quantitative analysis, LEC and rSI of the canalicular segment on T1 BB-FSE were larger than those on CE-GRE (p < 0.05). The T1 BB-FSE sequence was significantly superior to the CE-GRE sequence, with more conspicuous lesion visualization in terms of both qualitative and quantitative aspects in patients with facial neuritis.

scholarly journals Unique Case Report of a Meningeal Sarcoma Arising during Ongoing Treatment for Progressing Intraparenchymal Glioma

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Richard A. Peterson ◽  
Bhavani Kashyap ◽  
Pamala A. Pawloski ◽  
Anna C. Forsberg ◽  
Leah R. Hanson
Keyword(s):  
Radiation Therapy ◽  
Genetic Predisposition ◽  
Radiation Treatment ◽  
Tumor Resection ◽  
Tp53 Gene ◽  
World Health ◽  
High Grade ◽  
Who Grade ◽  
Li Fraumeni Syndrome ◽  
High Grade Sarcoma

Radiation-induced sarcomas in the brain are extremely rare, usually occur with an average latency of 9 years, and are associated with poor outcomes. Latency periods shorter than 1 year may indicate a genetic predisposition such as Li-Fraumeni syndrome. A 34-year-old man underwent initial tumor resection and radiation therapy for a World Health Organization (WHO) Grade II Astrocytoma. Within 6 months, the tumor recurred as WHO Grade III and was treated with temozolomide and then bevacizumab. Despite the patient’s apparent improving condition, MRI revealed new dural-based lesions 10 months after radiation therapy and identified as high-grade sarcoma. The patient resumed bevacizumab, began NovoTTF treatment for progressing glioma, and ifosfamide/doxorubicin for the sarcoma. Genetic testing revealed no pathogenic mutation in the TP53 gene. Ultimately, treatment was unsuccessful and the patient succumbed to glioma and sarcoma within 2 years of initial diagnosis. This case was unique due to the rapidly progressing glioma and sudden appearance of a high-grade sarcoma. It is unusual to have two separate intracranial primary cancers with each requiring a different chemotherapy regimen. We discuss the difficulty of simultaneously treating with separate chemotherapy regimens. It remains unclear whether the sarcoma was induced by the radiation treatment or a genetic predisposition.

Use of Magnetic Resonance Imaging to Assess Blood-Brain/Blood-Glioma Barrier Opening During Conformal Radiotherapy

2005 ◽  
Vol 23 (18) ◽  
pp. 4127-4136 ◽  
Author(s):  
Yue Cao ◽  
Christina I. Tsien ◽  
Zhou Shen ◽  
Daniel S. Tatro ◽  
Randall Ten Haken ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Conformal Radiotherapy ◽  
High Grade ◽  
Resonance Imaging ◽  
Blood Brain ◽  
Contrast Enhanced ◽  
Tumor Region ◽  
Region Contrast ◽  
High Grade Gliomas

Purpose For chemotherapy to act synergistically and safely with radiation against high-grade gliomas, drugs must pass the endothelial junctions of the blood-tumor barrier (BTB) to reach all tumor cells, and should not pass the blood-brain barrier (BBB) to cause toxicity to normal brain. The objective of this study was to assess BBB/BTB status using magnetic resonance imaging (MRI) during a course of radiotherapy of high-grade gliomas. Patients and Methods Sixteen patients with grade 3 or 4 supratentorial malignant glioma receiving conformal radiotherapy (RT) underwent contrast-enhanced MRI before, during, and after completion of RT. A gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) uptake index was analyzed with respect to the tumor and RT dose received. Results In the nonenhanced tumor region, contrast uptake increased significantly after the receipt of approximately 10 Gy (P < .01), and reached a maximum after the receipt of approximately 30 Gy. In the initially contrast-enhanced tumor region, contrast uptake decreased over the course of RT and became significant after completion of RT in patients without progressive disease. The healthy brain showed only nonsignificant changes during and after irradiation. Conclusion Contrast MRI reveals increases in Gd-DTPA uptake in the initially nonenhanced tumor region but not in the remaining brain during the course of RT, suggesting opening of the BTB. This finding suggests that the effect of conformal radiation is more selective on the BTB than the BBB, and there may be a window extending from 1 week after the initiation of radiotherapy to 1 month after the completion of treatment during which a pharmaceutical agent has maximum access to high-grade gliomas.

scholarly journals Molecular Imaging of Carotid Plaque Vulnerability

2014 ◽  
Vol 39 (1) ◽  
pp. 5-12 ◽  
Author(s):  
Angelika Alonso ◽  
Dimitrios Artemis ◽  
Michael G. Hennerici
Keyword(s):  
Molecular Imaging ◽  
Carotid Endarterectomy ◽  
Contrast Enhancement ◽  
Phase Contrast ◽  
Late Phase ◽  
High Grade ◽  
Contrast Enhanced Ultrasound ◽  
Plaque Vulnerability ◽  
Carotid Plaques ◽  
Contrast Enhanced

Background: Carotid endarterectomy (CEA) has been shown to be beneficial in patients with high-grade symptomatic carotid artery stenosis. Patients with high-grade asymptomatic stenosis may only exceptionally benefit from CEA during periods of increased plaque vulnerability. Imaging modalities to characterize unstable, vulnerable plaques are strongly needed for better risk stratification in these patients. Summary: Contrast-enhanced ultrasound (CEUS) is a novel and noninvasive technique capable to identify several surrogate markers of vulnerable carotid plaques. The use of specific ultrasound microbubbles allows a reliable detection of microulcerations due to an optimized visualization of the plaque-lumen border. As microbubbles are strictly intravascular tracers, the detection of individual microbubbles within the plaque corresponds to intraplaque neovessels. The accuracy of CEUS in the visualization of newly formed microvessels has been confirmed in histological studies on carotid endarterectomy specimens. Together with the formation of adventitial vasa vasorum, intraplaque neovascularization is a strong predictor for symptomatic disease. The phenomenon of late phase contrast enhancement is based on the adherence of microbubble-containing monocytes on inflamed endothelium. Recent studies suggest that late phase contrast enhancement may reflect endothelial inflammation or activation within carotid plaques. The development of conjugated microbubbles that bind to specific ligands such as thrombotic material or neovessels has led to the term ‘molecular imaging'. CEUS with microbubbles targeted to P-selectin and VCAM-1, key molecules in leukocyte trafficking, was used to detect an inflammatory plaque phenotype, whereas microbubbles coupled to the VEGF-receptor may allow for a detection of neovascularization. Even though imaging with targeted microbubbles is yet in an experimental stage, this technique can visualize active plaque reorganization with increased vulnerability leading to generation of arterio-arterial embolism. Key Messages: The use of contrast-enhanced ultrasound can be recommended to assess atherosclerotic carotid lesions at risk for rupture. Prospective clinical studies are needed to validate the use of CEUS in patients with high risks of recurrent large artery strokes. In particular, this applies to the detection of intraplaque neovascularization, a well-established marker in preclinical and observational studies, while the clinical significance of late phase contrast enhancement still needs to be determined.

scholarly journals Potential CanonicalWntPathway Activation in High-Grade Astrocytomas

2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Rebecca Schüle ◽  
Christine Dictus ◽  
Benito Campos ◽  
Feng Wan ◽  
Jörg Felsberg ◽  
...  
Keyword(s):  
Direct Sequencing ◽  
Luciferase Reporter ◽  
High Grade ◽  
Luciferase Reporter Gene ◽  
Protein Truncation Test ◽  
Who Grade ◽  
Transcriptional Cofactors ◽  
Pathway Activation ◽  
Gene Assay ◽  
High Grade Gliomas

Aberrantwntpathway activation through cytoplasmic stabilization ofβ-catenin is crucial for the development of various human malignancies. In gliomagenesis, the role of canonical (i.e.,β-catenin-dependent) signalling is largely unknown. Here, we studied canonicalwntpathway activation in 15 short-term cultures from high-grade gliomas and potential pathomechanisms leading to cytoplasmicβ-catenin accumulation. Furthermore, we assessed the prognostic relevance ofβ-catenin expression in a tissue microarray comprising 283 astrocytomas. Expression ofβ-catenin, its transcriptional cofactors TCF-1 and TCF-4 as well as GSK-3βand APC, constituents of theβ-catenin degradation complex was confirmed by RT-PCR in all cultures. A cytoplasmicβ-catenin pool was detectable in 13/15 cultures leading to some transcriptional activity assessed by luciferase reporter gene assay in 8/13. Unlike other malignancies, characteristic mutations ofβ-catenin and APC leading to cytoplasmic stabilization ofβ-catenin were excluded by direct sequencing or protein truncation test. In patient tissues,β-catenin expression was directly and its degradation product's (β-catenin-P654) expression was inversely correlated with WHO grade. Increasedβ-catenin expression and lowβ-catenin-P654 expression were associated with shorter survival. Altogether, we report on potential canonicalwntpathway activation in high-grade gliomas and demonstrate thatβ-catenin expression in astrocytomas is associated with increased malignancy and adverse outcome.

scholarly journals Effects of artery input function on dynamic contrast-enhanced MRI for determining grades of gliomas

2020 ◽  
pp. 20200699
Author(s):  
Lin Jia ◽  
Xia Wu ◽  
Qian Wan ◽  
Liwen Wan ◽  
Wenxiao Jia ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Input Function ◽  
P Value ◽  
Low Grade ◽  
High Grade ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Quantitative Parameters ◽  
Contrast Enhanced ◽  
High Grade Gliomas

Objective: To evaluate the effect of artery input function (AIF) derived from different arteries for pharmacokinetic modeling on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters in the grading of gliomas. Methods: 49 patients with pathologically confirmed gliomas were recruited and underwent DCE-MRI. A modified Tofts model with different AIFs derived from anterior cerebral artery (ACA), ipsilateral and contralateral middle cerebral artery (MCA) and posterior cerebral artery (PCA) was used to estimate quantitative parameters such as Ktrans (volume transfer constant) and Ve (fractional extracellular-extravascular space volume) for distinguishing the low grade glioma from high grade glioma. The Ktrans and Ve were compared between different arteries using Two Related Samples Tests (TRST) (i.e. Wilcoxon Signed Ranks Test). In addition, these parameters were compared between the low and high grades as well as between the grade II and III using the Mann-Whitney U-test. A p-value of less than 0.05 was regarded as statistically significant. Results: All the patients completed the DCE-MRI successfully. Sharp wash-in and wash-out phases were observed in all AIFs derived from the different arteries. The quantitative parameters (Ktrans and Ve) calculated from PCA were significant higher than those from ACA and MCA for low and high grades, respectively (p < 0.05). Despite the differences of quantitative parameters derived from ACA, MCA and PCA, the Ktrans and Ve from any AIFs could distinguish between low and high grade, however, only Ktrans from any AIFs could distinguish grades II and III. There was no significant correlation between parameters and the distance from the artery, which the AIF was extracted, to the tumor. Conclusion: Both quantitative parameters Ktrans and Ve calculated using any AIF of ACA, MCA, and PCA can be used for distinguishing the low- from high-grade gliomas, however, only Ktrans can distinguish grades II and III. Advances in knowledge: We sought to assess the effect of AIF on DCE-MRI for determining grades of gliomas. Both quantitative parameters Ktrans and Ve calculated using any AIF of ACA, MCA, and PCA can be used for distinguishing the low- from high-grade gliomas.

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